| NPI | 1932111747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 1143) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: TX 22443) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2025-09-11 |